Tip position of a central venous access is of paramount importance and should be verified before starting infusion. Intra-procedural methods for verifying the location of the tip are to be preferred, since they avoid the risks, delays and costs of repositioning the tip. Among the intra-procedural methods, the electrocardiography (ECG) method has many advantages since it is as accurate as fluoroscopy, but simpler, more readily available, less expensive, safer and more cost-effective. When dealing with the insertion of peripherally inserted central catheters (PICC), the ECG method (using the column of saline technique) virtually has no risk of false positives. The ECG method removes the need for the post-procedural chest x-ray, as long as there is no expected risk of pleuropulmonary damage to be ruled out (example: ultrasound guided central venipuncture for central venous catheter insertion or any kind of PICC insertion). In conclusion, evidence is mounting that the ECG method may be a valid and cost-effective alternative to the standard radiological control of the location of the tip of any central venous access device (VAD), and that will rapidly become the preferential method for confirming the tip position during PICC insertion.
Currently, the verification of the tip location of a central venous line may be achieved at the end of the procedure using various imaging techniques, such as MR, CT scan, standard trans-thoracic echocardiography, or TEE (trans-esophageal echocardiography). The most commonly used “post-procedural” method (and one of the most cost-effective) is the standard post-procedural chest x-ray. However, checking the position of the tip of the catheter during the procedure is preferable to a post-procedural control (6). During catheter insertion, the correct position of the catheter tip can be checked by several different methods:                intra-operative fluoroscopy and/or intra-operative control radiography;        standard trans-thoracic echocardiography or transesophageal echocardiography;        the electrocardiographic method (intracavitary ECG);        electromagnetic and infrared light guidance        Doppler ultrasoundEach of these methods has certain advantages and disadvantages, such that today, the most widely accepted and used method is the post-procedural x-ray although, as it has been shown by different studies, the ECG methods could become the method of choice. The present invention describes several new devices for central venous lines guidance optimized for the ECG method.        
The present invention addresses the existing clinical and technical problems in several ways. In one aspect of the invention a new device and a method are described which allow for making an electrical connection between an electrolyte and an electric wire. In one embodiment, the electric wire is shielded. In another aspect of the invention a new connector is described which allows to be used by a single sterile operator. In another aspect of the invention a valved device is described which allows for maintaining the integrity and the pressure of a saline column in the central venous line. In another aspect of the invention a device is described which allows for automatically maintaining a continuous flush of a saline syringe in order to allow for keeping the valves of central venous lines open and capable of electric conduction. In another aspect of the invention several devices are described which allow for making a selective electrical connection of certain elements of central venous lines to a connecting wire while isolating other certain elements of central venous lines from electrical contact. In another aspect of the invention a syringe is described which allows for simultaneous electrical connection between the fluid in the syringe and an electrical wire. The devices described in the present invention can be used for guiding and verifying the catheter tip placement using the ECG method during the placement procedure and any time post-procedurally.